DESCRIPTION Optimizing Dementia Outcomes in the Community Anticipated Impacts: This goal of this career development proposal is to acquire the knowledge, skills and experience necessary to champion a rehabilitation-focused research agenda that will establish optimal interventions for promoting functioning, treating indicators of distress, and maintaining meaningful interpersonal engagement that impacts quality of life and basic daily living activities in the early and moderate stages of dementia. A primary aim of the proposed work is to understand the scope of the unmet needs of a cognitively impaired veteran population in a rural setting and to identify optimal dyadic (veteran/caregiver) approaches for intervention. A pilot telephone-based rehabilitative intervention will be developed. The impact of this work will be realized when an efficacious and highly-accessible rehabilitation intervention, such as the telephone-based psychoeducational intervention being piloted, becomes available. Background: Over 5.4 million individuals in the US are diagnosed with related dementing disorders. Determining optimal community-based interventions to maintain veterans at home rather than inpatient facilities should be at the forefront of dementia planning strategies. Traditional psychosocial and psychoeducational interventions that target increasing caregiver skills and coping need to be paired with patient-centered rehabilitation-focused modules for the individuals with early and moderate stages of dementia to promote optimal functioning that will impact quality of life through increased physical independence, social engagement, reduced pain/distress, and maintenance of abilities and identity into the later stages of the disease. Yet, existing skill-basd interventions take an either/or approach - focusing on the needs of either the individual with dementia or the family member who is providing care. Yet, the social, physical, medical, and mental health needs of these individuals are often intimately linked, and a healthy relationship between these individuals is essential for maintaining care in the home for as long as possible. A recent evidence synthesis concluded that patient-centered multi-component interventions sensitive to the needs of the dyad offer the most promise for effects on diverse outcomes. At particular risk of under recognition and limitations in access to resources are rural-residing veterans. Objectives: 1) To conduct qualitative interviews with veterans and their families who live in rural areas and have been identified on a cognitive screen as experiencing cognitive deficits to determine their perceived needs and gaps in VA rehabilitation and health care supports as it applies to cognitive functioning and rehabilitation; and 2) to modify an evidence-based psychosocial intervention called Preventing Aggression in Veterans with Dementia, for use with veterans and their caregivers to examine the feasibility and necessary infrastructure of conducting this intervention with individuals with dementia and their family support by phone rather than in person as it was originally designed. We anticipate that this modification will increase utilization and access to dementia care in rural veteran populations. Dr. Hilgeman plans to obtain additional training under the mentorship of well-established VA researchers in the following areas: 1) dementia; 2) mixed-methods intervention development and clinical trial design; 3) rehabilitation science and interventions; and 4) rural health and telemedicine technologies. The primary outcomes will be qualitative themes generated from interviews with veterans about perceived needs as well as preliminary quantitative and qualitative data addressing the feasibility and likely outcomes of the modified phone-based intervention. PUBLIC HEALTH RELEVANCE: Optimizing Dementia Outcomes in the Community is a timely career development proposal given that more individuals with dementia will seek services from the VA over the next 10 years than at any point in our nations' history. It is responsive to priority areas of the Office of Research Development and the Rehabilitation R&D Service. The application is a pilot study and training plan that will prepare Michelle Hilgeman, Ph.D. for a career addressing translatable rehabilitative strategies and interventions that increase management of rurally- residing veterans with dementias across the continuum of the disease to increase communication, identify and manage pain, increase engagement in meaningful social interactions, and ultimately delay institutionalization through family-centered behavioral and psychosocial interventions. Defining optimal rehabilitation and recovery outcomes for aging veterans in the home is an important contribution for community-dwelling aging veterans and their families, particularly in rural communities with diminished access to specialty health care resources.